David Dossetor

The University of Sydney, Psychological Medicine, Faculty Member

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Medicine and the Community Medicine and the Community

A child in detention: dilemmas faced by health professionals

Psychiatric comorbidity is common in dystonia and other movement disorders

Archives of Disease in Childhood, 2020

ObjectiveTo determine rates of psychiatric comorbidity in a clinical sample of childhood movement... more ObjectiveTo determine rates of psychiatric comorbidity in a clinical sample of childhood movement disorders (MDs).DesignCohort study.SettingTertiary children’s hospital MD clinics in Sydney, Australia and London, UK.PatientsCases were children with tic MDs (n=158) and non-tic MDs (n=102), including 66 children with dystonia. Comparison was made with emergency department controls (n=100), neurology controls with peripheral neuropathy or epilepsy (n=37), and community controls (n=10 438).InterventionsOn-line development and well-being assessment which was additionally clinically rated by experienced child psychiatrists.Main outcome measuresDiagnostic schedule and manual of mental disorders-5 criteria for psychiatric diagnoses.ResultsPsychiatric comorbidity in the non-tic MD cohort (39.2%) was comparable to the tic cohort (41.8%) (not significant). Psychiatric comorbidity in the non-tic MD cohort was greater than the emergency control group (18%, p<0.0001) and the community cohort (...

format_quoteThe DSM-5 diagnosis rate for tic disorders was 41.8% compared to 39.2% for non-tic movement disorders; both significantly higher than emergency controls (18%).format_quote

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Young People with Learning Disabilities

Child Psychology and Psychiatry, 2017

Intellectual Ability, Self-perceived Social Competence, and Depressive Symptomatology in Children with High-functioning Autistic Spectrum Disorders

Journal of Autism and Developmental Disorders, 2006

Although social competence deficits in children with high-functioning autistic spectrum disorders... more Although social competence deficits in children with high-functioning autistic spectrum disorders (HFASD) are well documented, there is little research investigating self-perceptions of social limitations. This study replicated research showing a negative association between self-perceived social competence and intellectual ability and investigated associations between self-perceived social competence and depressive symptomatology. Participants were 22 children with HFASD, aged 7-13 years with intelligence quotient (IQ) scores of 82-141. Parent-(N = 18) and teacher-(N = 17) rated social competence was lower for children with HFASD compared with a normative sample. Higher age and IQ predicted lower levels of self-perceived social competence, and low self-perceived social competence predicted higher levels of depressive symptomatology. Almost a third of children rated themselves for depression; parent ratings suggested even higher levels.

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The Youngest Case of Pervasive Refusal Syndrome?

Clinical Child Psychology and Psychiatry, 2000

To date, the youngest previously recorded case of pervasive refusal syndrome (PRS) was eight year... more To date, the youngest previously recorded case of pervasive refusal syndrome (PRS) was eight years old. A four-year-old Australian-born Chinese boy presented to a tertiary paediatric referral centre with a four-week history of food refusal and selective mutism; he was severely dehydrated and marasmic. During admission several behavioural problems were noted including: persistent refusal to eat or drink, obsessions with images of food, failure to cooperate, lack of social interaction and toileting in inappropriate places. There were features of early maternal separation, concerns over the quality of parenting and confusion of language and culture. An exhaustive assessment (to exclude an organic explanation) by a multi- disciplinary team was completed. All investigations were normal with the exception of the single photon emission computerized tomography (SPECT) scan, which showed mild increase uptake to the right insular and mild decrease uptake to the right temporal region. He was h...

A Global Scale to Measure the Quality of the Family Environment

Archives of General Psychiatry, 1997

Background: Simple, reliable measures of the quality of the environment in which a child was rear... more Background: Simple, reliable measures of the quality of the environment in which a child was reared that can be used in clinical research and practice are lacking. Method: The reliability and validity of a global scale to retrospectively appraise the quality of that environment were examined. Fifty-three clinicians from 4 centers in Australia and 1 in Hong Kong, People's Republic of China, used the scale to rate 7 case vignettes; 4 clinicians rated 20 medical records, and 49 rated 211 subjects after clinical interviews. Results: Interrater reliability (intraclass correlation coefficient) was 0.82 (time 1) and 0.84 (time 2) for case vignettes, 0.90 for medical records, and 0.89 for clinical interviews. Consistency in time was high (r=0.91). Lower ratings, indicative of a less adequate environment, were associated with a clinical diagnosis of oppositional defiant or conduct disorder. Conclusions: Our simple-to-use scale appears to measure reliably a relevant clinical construct and fills a gap among the instruments available. Ratings may be useful as a cost-effective index to consider in outcome studies, when examining response to treatment, or in other clini-From the

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All That Glitters Is Not Gold': Misdiagnosis of Psychosis in Pervasive Developmental DisordersA Case Series

Clinical child psychology and psychiatry, 2007

The early literature established the validity of the distinction between early onset schizophreni... more The early literature established the validity of the distinction between early onset schizophrenia and autism. In the modern context of increasing recognition of pervasive developmental disorders (PDD) and a growing interest in very early onset schizophrenia and other childhood onset psychoses, this clinical distinction is often difficult to make. This article looks at problems arising from overdiagnosing psychosis in those with PDD. Four case examples of misattributed diagnosis of psychosis are described. The features that were mistaken for psychotic phenomena are described and explained and successfully treated in the context of a diagnosis of PDD. The article describes problems of reliability of ascertaining subjective mental phenomena and the range of mental phenomena that need to be recognized in PDD. The overlap of abnormal perceptions and cognitions in both these conditions is described with reference to the literature. It is evident that more needs to be done to improve diagnostic reliability of psychosis in PDD, by improving clinical awareness and research tools.

format_quoteReported autism rates have significantly increased, suggesting broader recognition in clinical settings across populations.format_quote

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Self-reported emotion regulation in children with autism spectrum disorder, without intellectual disability

Research in Autism Spectrum Disorders

Severe movement disorder and psychosis from haloperidol withdrawal in a 7‐year‐old girl with autism

Journal of Paediatrics and Child Health

Effect of Fluoxetine on Obsessive-Compulsive Behaviors in Children and Adolescents With Autism Spectrum Disorders

JAMA

IMPORTANCE Selective serotonin receptor inhibitors are prescribed to reduce the severity of core ... more IMPORTANCE Selective serotonin receptor inhibitors are prescribed to reduce the severity of core behaviors of autism spectrum disorders, but their efficacy remains uncertain. OBJECTIVE To determine the efficacy of fluoxetine for reducing the frequency and severity of obsessive-compulsive behaviors in autism spectrum disorders. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, placebo-controlled clinical trial. Participants aged 7.5-18 years with autism spectrum disorders and a total score of 6 or higher on the Children's Yale-Brown Obsessive Compulsive Scale, modified for pervasive developmental disorder (CYBOCS-PDD) were recruited from 3 tertiary health centers across Australia. Enrollment began November 2010 and ended April 2017. Follow-up ended August 2017. INTERVENTIONS Participants were randomized to receive fluoxetine (n = 75) or placebo (n = 71). Study medication was commenced at 4 or 8 mg/d for the first week, depending on weight, and then titrated to a maximum dose of 20 or 30 mg/d over 4 weeks. Treatment duration was 16 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the total score on the CYBOCS-PDD (scores range from 0-20; higher scores indicate higher levels of maladaptive behaviors; minimal clinically important difference, 2 points) at 16 weeks postrandomization, analyzed with a linear regression model adjusted for stratification factors (site, age at baseline, and intellectual disability), with an additional prespecified model that included additional adjustment for baseline score, sex, communication level, and imbalanced baseline and demographic variables. RESULTS Among the 146 participants who were randomized (85% males; mean age, 11.2 years), 109 completed the trial; 31 in the fluoxetine group and 21 in the placebo group dropped out or did not complete treatment. The mean CYBOCS-PDD score from baseline to 16 weeks decreased in the fluoxetine group from 12.80 to 9.02 points (3.72-point decrease; 95% CI, −4.85 to −2.60) and in the placebo group from 13.13 to 10.89 points (2.53-point decrease; 95% CI, −3.86 to −1.19). The between-group mean difference at 16 weeks was −2.01 (95% CI, −3.77 to −0.25; P = .03) (adjusted for stratification factors), and in the prespecified model with further adjustment, it was −1.17 (95% CI, −3.01 to 0.67; P = .21). CONCLUSIONS AND RELEVANCE In this preliminary study of children and adolescents with autism spectrum disorders, treatment with fluoxetine compared with placebo resulted in significantly lower scores for obsessive-compulsive behaviors at 16 weeks. Interpretation is limited by the high dropout rate, null findings of prespecified analyses that accounted for potentially confounding factors and baseline imbalances, and CIs for the treatment effect that included the minimal clinically important difference.

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Sensory dysregulation in tic disorders is associated with executive dysfunction and comorbidities

Movement Disorders

Improving Emotional Competence in Children With Autism Spectrum Disorder and Mild Intellectual Disability in Schools: A Preliminary Treatment Versus Waitlist Study

Behaviour Change

This pilot study evaluated the effectiveness of delivering a new cognitive behavioural interventi... more This pilot study evaluated the effectiveness of delivering a new cognitive behavioural intervention package ‘Emotion-Based Social Skills Training (EBSST) for Children with Autism Spectrum Disorder (ASD) and Mild Intellectual Disability (ASD + MID)’ in schools. Fourteen school counsellors nominated 75 children (aged 7–13 years) with ASD + MID to receive 16 sessions of EBSST in groups of 3–8 children in their schools. Parent and teacher pre-post ratings of emotional competence (Emotions Development Questionnaire), social skills (Social Skills Improvement System Rating Scales) and mental health (Developmental Behaviour Checklist) were collected. Forty-three children received 16 sessions of EBSST and 32 children were allocated to the 9-month waitlist control group. Teachers and parents also received six EBSST training sessions in separate groups at school. Significant improvements in parent and teacher ratings of emotional competence were found at posttreatment among children in the EBS...

An exploratory study into an adapted use of the Alert Program for tic disorder in children

Australasian Psychiatry

Objectives: This preliminary study explored whether an adapted approach to the Alert Program, tha... more Objectives: This preliminary study explored whether an adapted approach to the Alert Program, that uses sensorimotor strategies, might assist with management of tic disorders in children. The Alert Program, a program that uses sensorimotor strategies for self-regulation in children with neurodevelopmental disorders, had not been trialled with children with tic disorders. Methods: Ten children with tic disorder were assessed using the Dunn Sensory Profile 2 (SP2), the Yale Global Tic Severity Scale (YGTSS) and the Parent Tic Questionnaire (PTQ). Participants attended three 60–90-minute appointments with an occupational therapist and clinical psychologist for implementation of the adapted Alert Program. Results: The YGTSS showed tic reduction in all participants. The total YGTSS pre-intervention mean score of 46.5 improved to 17.7 post-therapy. Five participants reported no impairment post-therapy. PTQ scores reduced in nine participants. On the SP2, 30% of participants scored as havi...

A Pilot Study for Understanding the Perceptions of Australian General Practitioners Regarding Psychopharmacology for Children With Autism Spectrum Disorders

Journal of primary care & community health, Oct 20, 2016

General practitioners (GPs) are increasing involved in the care of children with autism spectrum ... more General practitioners (GPs) are increasing involved in the care of children with autism spectrum disorders (ASDs), and prescribe and/or manage psychotropic medications for these children. Few published reports of perceptions of GPs regarding use of these medications exist in the literature. Qualitative analysis of comments by 177 GPs regarding psychopharmacology use in children with ASDs. A postal questionnaire survey containing both close- and open-ended questions was conducted in New South Wales, Australia. Respondent GPs were more likely to be females graduated from Australian medical schools and reported an interest either in child or in mental health. The respondents demonstrated good understanding of the issues surrounding psychopharmacology use in children with ASD based on contemporary literature on this topic. The main themes included concerns regarding medication safety, evidence for their use, and role of these medications as an adjuvant to behavior management. GPs report...

A Framework for Developing a Curriculum Regarding Autism Spectrum Disorders for Primary Care Providers

Journal of clinical and diagnostic research : JCDR, 2015

The prevalence of Autism Spectrum Disorders (ASDs) has increased and varies across age groups. Th... more The prevalence of Autism Spectrum Disorders (ASDs) has increased and varies across age groups. Thus there is an increasing need for educational opportunities for General Practitioners (GPs) and other Primary Care providers to help in early identification and referral to specialist services. An earlier survey of GPs in New South Wales (Australia) demonstrated two broad domains for educational activities: (1) a general knowledge (important for early identification and referral) and (2) surveillance (important for ongoing management). To seek further evidence to these domains and synthesize the important contents for educational programs for GPs. We conducted a (1) Confirmatory Factor Analysis (CFA) on our original survey data and (2) systematic review of the literature to identify important educational topics, using a life cycle approach. CFA and literature review support theoretical framework of two domains. Alerts and red flags for ASDs, knowledge of simple surveillance tools, commu...

Emotion-Based Social Skills Training: A Controlled Intervention Study in 55 Mainstream Schools for Children with Autism Spectrum Disorder

Background: Children with Autism Spectrum Disorder (ASD) have significant difficulties with emoti... more Background: Children with Autism Spectrum Disorder (ASD) have significant difficulties with emotional understanding and emotion regulation. However, there is a dearth of evidence-based social-emotional programmes for children with ASD in schools. Emotion-based Social Skills Training (EBSST; Wong, Lopes & Heriot, 2010; Ratcliffe, Grahame & Wong, 2010) is a theory-based, developmentally appropriate group intervention which aims to enhance social-emotional skills in children across the Autism Spectrum. Objectives: This study aimed to evaluate the effectiveness of delivering EBSST to children with ASD, their parents and teachers by school counsellors in schools using a quasi-experimental treatment versus control group design. It was hypothesized that children in the treatment group would improve on teacher and parent report measures of emotion skills, social skills and mental health, across time (pre-treatment, post-treatment, and 6 month follow-up) compared to the control group. Method...

Multi-Site Randomised Controlled Trial of Fluoxetine in Children and Adolescents with Autism (FAB): Rationale and Design

Background: Serotonin reuptake inhibitors (SSRIs) are commonly prescribed ‘off -label’ for childr... more Background: Serotonin reuptake inhibitors (SSRIs) are commonly prescribed ‘off -label’ for children with autism despite caution regarding their use. To date, clinical trials examining the use of SSRIs in autism have been limited by small sample sizes and inconclusive results. The efficacy and safety of SSRIs for moderating repetitive stereotyped mannerisms in children with autism is yet to be examined. The aims of the FAB study are: * To determine the efficacy of low- dose fluoxetine compared to placebo, for reducing the frequency and severity of restricted, repetitive and stereotypic behaviours in children and adolescents with an Autism Spectrum Disorder (ASD). * To assess the safety of using low- dose fluoxetine. * To explore the relationship between the effectiveness of low- dose fluoxetine and the serotonin transporter genotype. Objectives: To describe the rationale and methodology of the FAB study and a summary of the patient profiles to date. Methods: The FAB study is a multi-...

Mental Health in Young People with Intellectual Disability and Autism

A Guide for Health Professionals Who Work with Adolescents and Young Adults, 2013

The Association Between Social Skills and Mental Health in School-Aged Children with Autism Spectrum Disorder, With and Without Intellectual Disability

Journal of autism and developmental disorders, Jan 11, 2015

Autism Spectrum Disorder (ASD) is associated with social skills deficits and co-occurring mental ... more Autism Spectrum Disorder (ASD) is associated with social skills deficits and co-occurring mental health difficulties. ASD frequently co-occurs with Intellectual Disability (ID). There is scant literature exploring the association between social skills and mental health in children with ASD, with or without ID. Participants were 292 children aged six to 13 with ASD (217 without ID; 76 with Mild ID). Parents and teachers rated social skills and mental health using standardised questionnaires. Greater mental health difficulties were associated with greater social responsiveness difficulties and poorer social skills across the sample. Effect sizes were large. Social skills explained a significant proportion of the variance in mental health scores across the sample. The study has important implications for treatment and future research.

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A child in detention: dilemmas faced by health professionals

The Medical journal of Australia, Jan 15, 2003

A 6-year-old child, held in detention with his parents pending the outcome of their application f... more A 6-year-old child, held in detention with his parents pending the outcome of their application for refugee status, manifested psychological distress by repeated episodes of refusing to eat or drink. This case presented clinical and ethical dilemmas for health professionals who were constrained from acting in the child's best interests by government policy of mandatory detention.

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